By R. P. R. Dawber, Ivan Bristlow, Jean Mooney
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Additional resources for The Foot: Problems in Podiatry and Dermatology
Example text
Diagnosis may be difficult—similar to other tumours or swellings such as fibroma (Figure 50), carcinoma in situ (Bowen’s disease), 44 Figure 45 Plantar warts—blackening, resolving lesions. Figure 46 Mosaic plantar wart. squamous carcinoma (Figure 51), or subungual corn (heloma) (Figure 52). Note that 65% remit spontaneously within 2 years. Fungal infections Dermatophytosis This is a fungal infection of the foot and toenails. At these sites, in clinical practice, dermatophytes are the most common fungi, sometimes saprophytes and rarely yeasts.
Occasionally, generalized ‘autosensitization’ eruptions occur in response to persistent focal fungal skin disease. Onychomycosis may be asymptomatic and no more than an ‘aesthetic compromise’ in its early stages. However, progression of the disease frequently leads to complications such as ingrowing toenail and the painful nail plate deformities of onychogryphosis and pincer or trumpet nail. Studies of onychogryphosis in the elderly show that many such patients had untreated onychomycosis at a younger age.
Isolated occurrences of onychocryptosis may be resolved by conservative removal of the offending spicule and packing the sulcus with cotton wool. Antibiotic cover should be given where secondary bacterial infection is suspected. Education is vital to minimize recurrence. Where the problem is recurrent, lateral nail avulsion, under local anaesthetic with phenolization of the associated matrix, is usually successful (see Therapies’, page 64). 26 Figure 21 Two examples of onychogryphosis—ram’s horn deformity.